TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT - EFFECT OF BILE LEAK ON SMOOTH-MUSCLE CELL-PROLIFERATION

PURPOSE: To evaluate the effect of bile on smooth muscle cell (SMC) pr oliferation in vitro and in vivo in a porcine transjugular intrahepati c portosystemic shunt (TIPS) model. MATERIALS AND METHODS: In vitro, S MCs explanted from porcine thoracic aorta were cultured with standard techniques. After initial pilot studies, they subcultured in one of th ree groups: 1% porcine serum plus 1% bile, 10% porcine serum plus 1% b ile, and 10% porcine serum. dells were harvested at 3, 10, or 14 days, and DNA, protein, and disintegrations per minute (an indicator of pro liferation), were measured. In vivo, TIPS creation was successful in 4 5 swine. Air pigs were euthanized at 10-16 days. The proliferative res ponse within the stent was histologically quantified and correlated fo r evidence of bile leak. RESULTS: In pilot studies, 2.5%-10.0% bile so lutions caused 100% SMC mortality by 3 days. In the presence of 1% bil e (with or without porcine serum), both DNA and protein production dec reased significantly compared with that in porcine serum alone (P < .0 5). In vivo, 13 of 45 specimens (29%) showed bile leak at gross or mic roscopic examination. SMC proliferation was less overall in animals wi th versus those without bile leak (difference not significant). CONCLU SION: These data suggest that the proliferative response in a TIPS is not primarily due to bile leak. Bile leak may promote thrombosis, but it appears to inhibit myointimal proliferation.